Shamsah Malik, DNP, MSN, ACNP-BC, CNS

Abstract:

Background: California’s naloxone law (AB 2760) mandates all providers to screen for overdose risk and co-prescribe naloxone to patients at risk of opioid overdose. However, naloxone co-prescription rates among general medicine providers remain low. This can be attributed to lack of knowledge regarding the overdose risk criteria and lack of a consistent standardized approach to prescribing opioids. Objective: This quality improvement (QI) project evaluated the impact of a naloxone provider education intervention coupled with a standardized approach for identifying patients at risk of opioid overdose, on provider knowledge and rates of naloxone co-prescription and overdose education when appropriate. Design/Setting: The project was designed as a pre and posttest analysis of change in opioid screening and naloxone prescriptions among the hospitalist providers at a Los Angeles County (LAC) hospital. Methods/Intervention: A survey assessing knowledge, attitudes and barriers for naloxone prescribing was administered at baseline and after the naloxone provider intervention. All providers were given a one-hour educational intervention focused on a standardized 5-Step process to be adopted for opioid screening and naloxone prescribing. Data were collected from medical charts on all patients discharged with an opioid prescription to determine if: (1) they met overdose risk criteria and (2) were subsequently co-prescribed naloxone, both in the six months before and four months after the educational intervention. For survey analysis, Friedman test was used across three time points and Wilcoxon's Signed-Rank with Bonferroni correction was used for pair-wise comparisons. Chi-square analysis was used to compare prescriber data pre- and post-intervention. Results: More naloxone prescriptions were written during the post-education phase, relative to baseline (68% vs 10%). Providers also educated more patients regarding opioid overdose and naloxone in the post-education phase (44% vs 6%). Providers screened more consistently for overdose risk post-intervention compared with baseline; thus, providing naloxone (85% vs 11%) and overdose education (55% vs 7%) to patients meeting criteria for overdose appropriately. Conclusion: Provider education and utilization of a standardized screening protocol customized for the provider context facilitated appropriate overdose screening, naloxone co-prescription and overdose education to patients. Keywords: opioids, overdose, overdose-risk criteria, naloxone, overdose education.

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